Abstract:

Introduction

There is increasing recognition of the importance of
clients of FSW as bridge group to HIV transmission. However, there is paucity
of evidence that establishes the HIV vulnerabilities or risk among clients in
India. The current analysis examines the changes in risk behaviors (condom
use), prevalence of HIV and STIs, and the factors associated with condom use
behaviors among clients of sex workers in three Indian states using data from a
large scale cross-sectional bio-behavioural survey.

Methods

Data were derived from two rounds of integrated
behavioural and biological assessments (IBBA) conducted among clients in the
years 2006 and 2009 in Andhra Pradesh, Tamil Nadu and Maharashtra, India. Eligible
clients for the survey included men aged 18 years or older who had bought sex
from a FSW at least once in the previous month.Two
stage probability sampling was used and time location clusters sampling was
applied. Consented participants completed structured interviews to collect
behavioural data and provided blood and urine samples for HIV, Neisseria
gonorrhea, Chlamydia trachomatis, and syphilis testing.

Results

Samples of 4,821 and 4,803 clients were covered in
IBBA rounds 1 and 2, respectively. The majority of the clients were literate,
ever married and worked as a laborer in two consecutive rounds. Over three
fourth of clients had first paid sex before age 25 years. Clients of FSWs had a
higher level of condom use during last sex act (AOR-2.5, 95% CI 1.9-3.3) and
consistent condom use (AOR-3.1, 95% CI-2.1-3.9) with occasional FSWs during
Round 2, compared with Round 1. Clients 24 years or younger (AOR=4.2; 95% CI:
2.9-6.2) were most likely to have reported consistent condom use with FSWs when
compared with clients 40 years or older. Clients who reported having sex with
other men, were less likely to report consistent condom use (AOR=0.63; 95% CI:
0.4-0.8) with FSWs. Clients who had exposure to messages on STIs or condom use
through media advertising were significantly more likely to report consistent
condom use with FSWs (AOR=1.6; 95% CI: 1.1-2.3). Logistic regression analysis
of factors associated with having an STI indicates that clients having sex with
another man have significantly higher likely hood of having an STI (9.1% versus
6.6%; AOR=1.8; 95% CI: 1.1 – 2.9).

Conclusion

The findings strongly suggest improvements in condom
use among the bridge population, which is also confirmed by the non-increase in
HIV and STI prevalence. Exposure to media messages on STIs and condom have
shown to positively influence condom use. These findings have programmatic
implications, in that it increases understanding about the sub-populations of
bridge populations more at risk and who need to be reached with more tailored
interventions.